🩺 Equine Hyperlipemia: A Vet’s 2025 Emergency Guide | Dr Duncan Houston BVSc

Meta description: ⚠️ A comprehensive 2025 vet’s guide on equine hyperlipemia—recognise, diagnose, treat, and prevent this emergency with Ask A Vet support.

1. 🧠 What Is Hyperlipemia?

Equine hyperlipemia is a serious metabolic condition characterized by mobilization of fat stores leading to elevated blood triglycerides and liver dysfunction. It typically affects ponies, minis, donkeys, and stressed or pregnant/lactating broodmares experiencing a negative energy balance. Without rapid intervention, it progresses to fatty liver syndrome, endotoxemia, and multi-organ failure.

2. ⚠️ Why It Happens

When a horse’s energy intake falls below requirements, hormones trigger excessive lipolysis, releasing free fatty acids and triglycerides into the bloodstream. The liver becomes overwhelmed, unable to process the lipid load—resulting in accumulation, inflammation, and impaired glucose production.

3. 👁️ Who’s Most at Risk?

• Ponies and miniatures: Higher metabolic sensitivity.
• Donkeys/mules: Similar predisposition.
• Pregnant and lactating mares: High energy demand, especially in late gestation.
• Stress burns: Adequate diet under stress (e.g., transport, illness) is critical.
• Insulin dysregulation/metabolic issues: Increases lipolytic drive and negative energy balance.

4. 🔍 Recognising Clinical Signs

• Depression and anorexia—even a brief feed refusal may trigger crisis.
• Weight/fat drooping—retroperitoneal, crest, tailhead are affected.
• Weakness, ataxia; uncommon but serious neurological signs with severe dysfunction.
• Bile buildup causes jaundice and hepatic pain.
• Low-grade fever; signs of endotoxemia: tachycardia, poor perfusion.
• Colic, gastrointestinal stasis, diarrhea—common after onset.

5. 🧪 Diagnosis & Laboratory Findings

• Serum triglycerides: >200 mg/dL is abnormal; >500 mg/dL confirms hyperlipemia.
• Liver enzymes: Elevated GGT, AST with hepatocellular stress.
• Cholesterol: Often increases, though less dramatic.
• Blood sugar and insulin: Monitor for concurrent dysregulation.
• Electrolytes: Check potassium, calcium for electrolyte disturbances.
• Additional tests: CBC and fibrinogen for early endotoxemia or inflammation; ultrasound to evaluate fatty liver if needed.

6. 🩺 Treatment Protocol

6.1 Restoring Energy Intake

Primary goal: reverse negative energy balance. Offer palatable feeds—like soaked beet pulp, bran mash, high-fat supplements (rice bran oils). Small frequent meals may encourage intake.

6.2 Parenteral Nutrition & IV Lipids

If anorexia persists, start nasogastric fluids with dextrose, or IV lipid emulsions. Collaboration with an equine hospital is advised when TPN is needed.

6.3 Intravenous Fluid Therapy

Support hydration and fluid volume, promote lipid excretion. May require 1–2× maintenance during acute phase.

6.4 Addressing Insulin Resistance

For horses with metabolic dysfunction, low-dose insulin therapy can reduce lipolysis. Example: recombinant human insulin protocol. Use under strict vet supervision.

6.5 Liver Supportive Care

Use hepatoprotectants (SAMe, milk thistle, vitamin E) and monitor bilirubin, enzymes. Antioxidants reduce liver cell damage.

6.6 Monitoring & Serial Testing

Check triglycerides daily until <200 mg/dL. Reassess liver enzymes, bloodwork every 48 hrs. Monitor for electrolyte imbalances.

6.7 Managing Complications

Gastroprotectants for colic/ulcers, NSAIDs for mild endotoxemia, antimicrobials if infection suspected. In severe cases, plasma or broad-spectrum antibiotics during SIRS support.

7. ✅ Prognosis

• Early intervention yields 70–80% recovery in good-condition animals.
• Poor prognosis if >1,000 mg/dL or advanced multi-organ failure.
• Pony type animals have slightly better recovery outcomes with prompt care.
• Key to survival: reversing anorexia and energy deficit quickly.

8. 🛡️ Prevention Strategies

• Identify at-risk horses: ponies, minis, broodmares, EMS cases.
• Ensure continuous access to forage: even when stressed or injured.
• Use feeding protocols: high-fat supplements proactively when appetite decreases.
• Limit fasting/stress: avoid long transport periods or stall confinement.
• Monitor weight: monthly body condition scoring; prompt action on feed refusal.
• Manage metabolic disease: prevent insulin resistance with diet and exercise.

9. 💬 Ask A Vet Guidance

• 📸 Upload photos/videos of body condition loss, fat drooping, or jaundice for rapid review.
• 📝 Get personalized treatment steps—fluid orders, diet tips, liver support regimens.
• 📆 Receive reminders to recheck triglycerides, monitor appetite, and support treatment phases.
• 🎓 Access webinars on metabolic emergencies, pony care, and hyperlipemia prevention by Dr Houston.

10. 🧩 Case Examples

Mini mare in early lactation: Refused feed postpartum, became dull with tailhead fat droop. Early dextrose fluids, bran mash, halved negative balance. Triglycerides dropped from 600 to 150 mg/dL in 48 hr. Recovered with continued diet and exercise plan.

EMS pony during stress: Fasting triggers droopy fat and mild colic. Prompt dietary changes with alfalfa hay stalls improved appetite within 24 hrs, preventing triglyceride rise.

11. ❓ FAQs

How fast does hyperlipemia develop?

In susceptible horses, triglycerides can double within 48 hrs of anorexia. Early detection saves lives.

Can lean horses get it?

Rare, but possible if anorexic and stressed. Lean hyperlipemia warrants same treatment urgency.

Is insulin therapy risky?

Low-dose insulin can aid recovery in resistant horses. Vet oversight is essential to avoid hypoglycemia.

Should I treat triglycerides before they reach 500 mg/dL?

Yes—levels above 200 mg/dL are concerning. Early intervention prevents full syndrome development.

12. 📆 Follow-Up & Rehabilitation

• Maintain feeding and monitoring for 3–4 weeks post-crisis.
• Gradually reintroduce turnout, light exercise to rebuild condition.
• Continue metabolic management if required—body score targets of 5–6/9.
• Frequent vet reviews and lab checks ensure stable recovery.

13. ✅ Final Takeaway

• Equine hyperlipemia is an emergency that strikes on negative energy balance
• Key triggers: anorexia, stress, metabolic disease in predisposed horses
• Immediate treatment focuses on reversing the energy deficit and supporting liver
• Early detection and proactive care can save >70% of affected horses
• Ask A Vet offers real-time support for prompt diagnosis, therapy guidance, and recovery monitoring 💙

🐾 Noticed Feed Refusal or Fat Drop? Alert Emergency

If your horse—especially a pony, mini, donkey, or broodmare—stops eating or shows fat drooping, contact Ask A Vet. As Dr Duncan Houston, I’ll help assess risk, run diagnostics, direct treatment, and monitor recovery—every crucial step to save your horse. ⚠️🐎